Framed in music terms, the U.S. healthcare debate has unfolded like an epic battle of the bands. For nearly a century politicians, doctors and private insurers have riffed on the subject, with each side hoping their proposed healthcare solutions would capture the grand prize of public approval. With the recent passage of the Patient Protection and Affordable Care Act, the debate continues and among the topics is how this historic legislation will impact the music community.

In reviewing the bill with an eye toward how it might apply to musicians, it is difficult to give the legislation a clean bill of health. Too much about the 2,400-page bill and its 10-year implementation plan is simply unknowable. However, the bill does include several provisions that could be beneficial to music professionals and their families — a group that has long struggled to balance employment, artistic fulfillment, health, and financial security.

As mandated by the new bill, most uninsured Americans will be required to purchase health policies starting in 2014, with consumers earning up to four times the federal poverty level qualifying for government subsidies. The mandate is probably a good thing considering the results of a 2002 Future of Music Coalition survey, which found that 44 percent of the 2,700 musicians queried didn't carry health insurance — almost three times the national average.

The bill bans insurance companies from dropping policyholders from coverage when they get sick. Private insurers will also be prohibited from refusing coverage to children with pre-existing conditions, a protection that will extend to all consumers in 2014. Until then, uninsured citizens with pre-existing conditions will receive immediate access to coverage through high-risk pools. "We see many people who are excluded from health insurance plans because of diabetes, a heart condition, hepatitis C, or cancer that they contracted five years ago," says Debbie Carroll, Executive Director of MusiCares, the health and human services organization established by The Recording Academy in 1989. "The pre-existing conditions clause is huge for [music professionals]."

Effective this year, a provision kicks in that requires new private insurance plans to cover preventive services with no co-payments or deductibles. Another clause allows children to remain on their parents' health plans until they are 26-years-old — a boon for young musicians. "Typically, young bands don't get their footing until they're a little bit older," says Carroll. "If they can be on their parent's plan instead of taking it on themselves, there's a greater chance that [medical expenses] will be taken care of."

Through new tax credits, small businesses will be able to purchase insurance for their employees, which may provide a boost to music entrepreneurs including studio owners, small publishers and even independent artists and bands. A less clear impact on business owners comes in 2014 when those companies with more than 50 workers will be required to offer employees health insurance or face penalties.

Despite many promising provisions and regulations, some Americans remain wary of the new healthcare legislation. A recent CBS News poll found 53 percent of Americans disapprove of the bill, while 32 percent approve and 15 percent are undecided.

A 2009 Harvard University study cited health care as the single largest factor in 62 percent of all U.S. personal bankruptcy cases in 2007. Confronted by this issue and other healthcare-related realities, Pearl Jam, Lou Reed, R.E.M., and Lucinda Williams, among other artists, have participated in benefit concerts and tribute recordings to help ailing comrades, including tributes for artists such as Victoria Williams, who contracted multiple sclerosis in 1993; Alejandro Escovedo, who was stricken with hepatitis C in 2003; Vic Chesnutt, who died in 2009 from an overdose of prescription muscle relaxants; and Marva Wright, who died from complications of a stroke in March.

But while such projects are helpful, they alone can not fully defray healthcare costs. "It used to be that you could have a [benefit] and pay off the person's bill," says Jim Brown, director of health services for the Actors Fund, a New York-based human services organization. "You can't do that anymore. Health care today can be hundreds of thousands of dollars."

Financial healthcare burdens have been so onerous that some musicians have resorted to drastic measures. Reportedly distraught over mounting medical bills, former Ted Nugent drummer Cliff Davies committed suicide in 2008. The problem for many musicians is the episodic and independent nature of professional music employment. While a majority of Americans are insured through their employers, many music industry professionals earn income in a non-union, work-for-hire capacity. As such, they are often forced to directly purchase costly individual health plans from modestly regulated private insurers.

"The difficulty for artists in this country is that much of our employment system depends on that steady 9-to-5 job," says Brown. "Many entertainers simply can't afford the insurance."

For Nashville, Tenn., music publicist Nicole Cochran, the search for affordable health care claimed nearly everything she has. Diagnosed with aggressive multiple sclerosis in 2004, Cochran, 39, was forced to close her Music Row office and lay off her employees in order to pay healthcare bills. "It was devastating," Cochran says. "I went blind. I had to re-learn how to walk. I lost all my savings. It was a struggle, to say the least."

With assistance from MusiCares and Nashville-based program Sound Healthcare, Cochran has reduced her medical bills, which average $3,000 per month. She is one of many Americans hoping to be accepted into the government subsidized high-risk pool. Though she believes the health bill is flawed, Cochran remains philosophical. "Anything is better than doing nothing," she says. "I strongly believe that we have to walk before we run."

Pledging a healthcare overhaul, Democrat Barack Obama won the presidency in 2008. A conservative movement erupted in response to the president's healthcare plans, with self-styled "tea party" protestors equating the president's reforms with Soviet-styled socialism. Liberal critics expressed disappointment when Obama ruled out the possibility of a "public option" — i.e., a government-run alternative to private insurers.

Just when it seemed reform was dead, Obama, encouraged by House Speaker Nancy Pelosi (D-Calif.), unveiled his own plan. The president then persuaded enough of his moderate Democratic colleagues to push the bill through. The House approved the $2.5 trillion overhaul, which the president signed into law on March 23.

Cochran, also a mother of a foster child, says the bill has given her renewed hope. A former Republican who switched parties over her reform convictions, she has experienced the healthcare debate from both sides.

"To me this is not a partisan issue — it's a compassion issue," Cochran says. "We're the wealthiest nation in the world, and it's absurd that people are dying without health care. This bill was the right thing."

(Bruce Britt is an award-winning journalist and essayist whose work has appeared in The Washington Post, USA Today, San Francisco Chronicle, Billboard and other publications. He lives in Los Angeles.)

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